﻿480 MUSGRAVE AND CLEGG. 



center; the second are the earlier, reddish, soft, fluctuating nodules, 

 which when opened seem to contain a dark material appearing like 

 venous blood. Stages of the lesions in character between these two 

 may be seen, and smaller nodules, from 2 to 8 millimeters in diameter, 

 resembling the large ones in all respects except that the} 7 contain no 

 openings, are also present. The skin in general is not much thickened, 

 but it is rather tense over the swollen subcutaneous and other tissues. 

 The openings on the cutaneous surface are directly continuous with 

 sinuses which run in all directions through the foot and which connect 

 freely with each other. It is very easy to section the foot, the knife 

 passing readily in all directions because of almost complete destruction of 

 the bony tissues. The cut surface shows a mass of disorganized and 

 degenerated tissue, without evidence of inflammation, and an abundance 

 of oily, slightly tenacious liquid exudes not only from these surfaces 

 but also from the' sinuses exposed by the section. This fluid contains 

 the so-called "fish roe" granules, which vary in size from those only 

 observable under the microscope to others 2 millimeters or more in 

 diameter. The masses have a yellowish color and when pressed out and 

 examined under the microscope are seen to be made up of degenerated 

 cells, debris, and the Streptothrix about to be described. 



Histology. — Nothing very definite can be observed in the sections. 

 There is uniform destruction of the tissues, with but slight evidence of 

 repair. Many specimens from all parts of the diseased foot were re- 

 moved for section and were prepared by the Zenker, alcohol and for- 

 malin, and by the Levacliti method ; and for purposes of study many 

 stains were used, including the Ziehl-Xeelson stain for tubercle bacilli ; 

 the Gram-Weigert ; Levaditi's methylene blue ; Wright's blood stain ; 

 Giemsa's and the general aniline' dyes. The first two of these were very 

 satisfactory, particularly the Gram-Weigert method. 



The following method used by Mr. Willvoung is particularly good 

 for studying sections of the larger granules : 



The tissue is stained in warm carbol-fuchsin for ten minutes, decolorized in 

 5 per cent nitric acid-alcohol for from five to fifteen seconds ; washed in water, 

 counter-stained for five minutes in a concentrated aqueous solution of methylene 

 blue ; washed in water, then in 95 per cent alcohol and finally in absolute alcohol, 

 cleared in xylol and mounted in balsam. With this stain the Streptothrix takes 

 a bright red color, whereas the tissues become blue. 



Sections taken from the skin at a distance from the openings demon- 

 strate very little change. In some places the walls of the small blood 

 vessels are thickened and in a few instances these are surrounded by an 

 area of moderate, round-cell infiltration. Sections through the margins 

 of the openings show a necrotic zone without any areas of infiltration, 

 or any other marked evidence of tissue repair or reaction. Some of 

 these sections contain small granules of the Streptothrix and in other 



